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 22 February 2018

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News

Screening men for aortic aneurysms justified and cost effective

The English authors of a study in this week's issue of the Lancet provide evidence that screening men over 65 could substantially reduce death from ruptured aortic aneurysms.

News image

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Rupture of an aortic aneurysm (a swelling in the main blood vessel from the heart) is a major cause of death among men over 65 years of age.

However, opinion is divided as to whether ultrasound screening could be effective in preventing death from ruptured aneurysms.

The Multicentre Aneurysm Screening Study (MASS) led by Alan Scott from St Richards Hospital, Chichester, UK, compared the effect of screening for aortic aneurysms among a population of 67,800 men, aged 65 years or over.

The researchers invited half the study participants to attend screening, while the other half were a control group not invited for screening.

Men who had aneurysms detected by screening (swellings larger than 3cm diameter) were followed up for an average of 4 years, with surgical intervention when specific criteria were reached.

The research team found that the relative risk of aneurysm-related death was reduced by around 50% among men who were screened, and around 40% in those who were invited for screening (65 compared with 113 deaths).

The absolute risk of these men dying from aortic aneurysms was around 2 per 1000 compared with just over 3 per 1000 for men in the control group.

Clinical and economic analysis provide clear evidence to support screening in elderly men.
BMJ
The team calculated that 710 men would need to be screened to prevent 1 aneurysm-related death.

In addition, 30-day death rates were 6% after elective surgery for an aneurysm, compared with 37% after emergency surgery (a more likely outcome for the men who were not screened).

Mr Scott commented, "Our results indicate that substantial reductions in aneurysm-related mortality could be achieved by the implementation of a population-screening programme”.

“In view of the much higher frequency of the condition among men, and the absence of evidence of effect of screening on the incidence of ruptured aneurysms in women, it would be logical to screen only men”.

“The suggestion in an earlier report that a national screening program could consist of a single aortic ultrasound scan at age 65 would be supported by our results."

Further analysis of the MASS trial is published in the latest British Medical Journal.

Researchers found routine screening for aortic aneurysms in older men to be cost effective.

Using data from the previously described trial, the research team assessed the cost effectiveness of ultrasound screening for abdominal aortic aneurysms in 67,800 men aged 65 to 74 years for up to 4 years.

Over 4 years, there were 47 fewer deaths related to abdominal aortic aneurysms in the screening group than in the control group, but the additional costs incurred were £2.2m (GBP).

After adjustment, the additional cost of the screening program was £63 per patient.

The cost effectiveness ratio was £28,400 per life year gained.

The team concludes, "The clinical analysis and this economic analysis of the MASS trial together provide clear evidence to support the cost effectiveness of this particular form of screening in elderly men".

Lancet 2002; 360(9345): 1531-9
15 November 2002

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